Health care in Spain

Is Spain on the verge of a public health-care crisis?

EARLIER this year, an immigrant in Spain was not feeling well and went to hospital with symptoms of tuberculosis (TB). He was refused tests and sent home. Not much later he felt so bad that he rushed to the emergency room where again he was turned away. Then he died.

Like many illegal immigrants, the man lived in a small space with ten others. As TB is a contagious disease, all ten are now also at risk. They are unlikely to get any help in Spain: following austerity measures and a legislative change in 2012, the government will not provide any of the estimated 873,000 non-registered immigrants with non-emergency health care. This could create a vast public health crisis in the very near future, warn researchers at the London School of Hygiene and Tropical Medicine (LSHTM).

A paper published on December 14th in the Lancet, a medical journal, sounded an alarm on the state of Spanish health care. So far European media attention has focused on the impact of austerity on health care in Greece, with reports of dramatic increases in HIV, mental illness, TB and the return of malaria. Greece made its cuts two years earlier than Spain did, so their impact became evident sooner. But the situation in Spain is just as worrying, warns Helena Legido-Quigley of the LSHTM, who fears that if the government doesn’t change course soon, similar outbreaks could very well happen in Spain.

As the crisis hit, the Spanish government cut spending on an already relatively lean health-care system. (Public health-care expenditure is 7% of GDP compared with an average of 7.6% across the European Union, 8.4% in Germany and 9.5% in Denmark.) Expenditure was reduced by 13.7% in 2012 and by 16.2% in 2013 (including social services). Some regions imposed additional cuts as high as 10%. As a result a significant part of the Spanish population is excluded from basic health care, which could in turn lead to public-health problems for the entire population.

Elena Urdaneta, from Doctors of the World, a non-profit organisation, says the policy is not only unfair but also extremely dangerous for public health. “You can exclude people, but you cannot exclude diseases.” Not vaccinating the children of migrants, for example, is not only mean, but also inefficient. It is much cheaper to vaccinate than to deal with the outbreak of a contagious disease. And yet this is starting to happen in several regions.

Even for those still entitled to health care, more treatments, including those needed for Hepatitis C and some cancers, now require the patient to pay for part of the medication. This has led to more people not taking the medicines they need but feel they cannot afford.

As the impact of such policies on health tends to lag a few years, the real public-health crisis will only become evident when it is too late, warns Ms Legido-Quigley. Health-care professionals fear that if nothing is done to reverse these policies, Spain is headed down a steep slope.

The price tag of controlling a TB outbreak in New York City in the 1990s, a whopping $1.2 billion, proved the value of prevention, which would have cost an estimated one-tenth of that, and saved much misery in the process. Spain's recent health-care cuts undercut efforts at prevention. They risk dismantling a system that until very recently was one of the best in Europe, in terms of value for money.

"As a result a significant part of the Spanish population is excluded from basic health care, which could in turn lead to public-health problems for the entire population". Sorry, but the person who has written this must be misinformed. I'm a Spanish citizen and though it's true spending cuts might have an impact on health care quality on the long run,we all still have access to basic and specialised public health care in this country.

This is a really important piece. The fact is that whilst 'citizens' can still access healthcare, the most at risk group as far as public health and infectious disease are conerned (immigrants) are excluded. This substantial group is hidden as far as Spanish citizens go but pose a huge threat in health terms if the vital public health programmes for them are turned off. I think that's the point the writer makes which is really crucial.

The worst part of this is that the Spanish government doesn't seem to react. They go ahead with their "austerity measures" and make no excuse for the devastating effects they're having on various (weaker and/or deprived) sections of the population. The death of the Senegalese man was hardly reported in the media. I can't help but think that only the brave and independent (academics, NGOs, some media outlets) can speak out about what's going on. Spain is not only reducing its expenditure on vital and basic healthcare, it is also cracking down on complaints and criticism. Where is all this going??

Guest and Amalio - yes, a great tragedy. But unfortunately it's not just health, all other public services are at risk. Europe cannot claim to be unaware and cannot escape censure for at worst causing and at best looking the other way while European citizens see their welfare resources destroyed.

Just a reminder that at the start of EU intervention, Spain was forced to change its constitution to give repaying bank debt absolute priority over every other expenditure. The new right wing government has enforced this commitment to an unwise degree, and the consequences on the social and economic fabric are already only too visible.

I´m also a Spanish citizen and I can assure that 800.000 people are already excluded from the public healthcare system, they are just entitled to received emergency treatment. And the main problem is that the system has changed from an universal one to another where some groups are excluded, and that seems just the beginnig. The law excluding unemployed people going abroad to seek a job is about to be passed. Now that the door is open, and the crisis excuse seems to be a long term one, there is little doubt new groups will be excluded very soon. Thanks to back this policies with your inaccurate comment

I guess this change in the constitution was a movement made by the establishment parties (both conservative and social democratic parties signed the amendment)to ensure that if in the future they are not longer in power processes like those started in latin america (re negociating the debt and encouraging the national industry) are a little bit more difficult

Exactly, guest, it's no longer a universal system and change is being forced through in a chaotic and worrying way. Wait for the new highly regressive abortion bill for even further health and welfare complications.

I suppose that this article was so grossly disheartening that, upon shareing it, not one of my Facebook friends 'liked' it.
I'm actually glad that no one 'liked' it (no sarcasm intended, I'm seriously glad that it was not 'liked').
I'd be surprised if anyone objected to encouraging thriving and prosperous healthcare systems (private and/or public).
This Christmas I wish for those, who don't have the sustainable healthcare system that I have been blessed with, all the hope in the world to one day be treated as I am today.
No! In fact, I'll do all you who don't have what I have, one better! I will pledge my life's work to push for sustainable healthcare systems WORLDWIDE. I want the world to have what I, and others in Australia, often take for granted. I want sustainable and equitable healthcare systems to be as ubiquitous as the oxygen in which every man, woman and child breathes.
It's going to be a rough, long journey, however everyday I'll hold myself to account and will give you my word right now in this 'comment' to follow through.
For what are we, if we haven't something to fight for that's 'good' in this world?
I realise that as of current I am young and naïve, however we all have to start from somewhere in life. Whether it be 'baby steps' today, or colossal steps tomorrow, the most important thing is what lies at the end of it all.
I dream that one day, those reading this now can celebrate what 'good' has become of this world. A small voice, to a gargantuan achievement!
Merry Christmas to all creatures; great and small!
With regards,
Christian A.

Excellent article on the absolute importance of disease prevention, health promotion to prevent outbreaks, epidemics and pandemics. Some how this piece keeps getting ignored in the continuum of health (primary, acute, tertiary) leaving us with an unfinished, incomplete and dangerous health strategy.

No one is denied health care in this country. The problem is our system has been abused (by Spanish and non-Spanish citizens) for years, ill-perceived as “free”, when the truth is we all pay for it. Resources are no limitless. Immigrants are not denied health care but I guess an illegal one would have to produce some kind of papers to be treated. In case of an emergency no one is denied care. If, for instance, I travel to the US as a tourist and I have a medical problem I would have to pay for it. I don’t see why Spain would have to behave as an NGO.

You can not even imagine the difficulties immigrants find to receive healthcare. There are thousands of people in terrible situations: diabetes mellitus patients without insuline, aids patients without proper checks to follow up the evolution of the illness, people with cancer in terminal condition being refused for paliative care units (that means dying in terrible pain). And this is only part of the picture. The law says that emergency care has to be provided to everybody, but not always is the case, and many times it finishes before the problem is over. This week the Valencia region government lunched an insurance that costs more than 1000 euros per year (which is more expensive than a private one). Nobody, except, may be, rich russian tourists living in benidorm, is gonna be able to pay for it. The situation is critical, and is not a matter of cutting expends, because every study says is cheaper to treat every person in the initial stages of the disease than allow the problems to grow bigger. The whole thing is an ideological issue. They wanna pass the idea that private healthcare is better and cheaper, and that for years spaniards have over used the public system. But, first, the spanish system works reasonably well, and second, if there is any kind of problem is not because it´s a public system, it´s because the polititian in charge are not doing the right things. We should get rid of them, they are the problem not the public health system. But their final goal is to chopped the system and sell it at a bargain price to their fellow class (social class) mates